Acute myocardial infarction or not so much…

We present a 71-year-old woman, with personal history of hypertension and dyslipidemia, but unknown ischemic cardiomyopathy. After several episodes of chest / epigastric pain that led her to the emergency room, she start treatment with dual antiplatelet therapy because of what was assumed has a myocardial infarction without ST elevation. Despite the hemodynamic stability and slight increase in cardiac enzymes, due to recurrent symptoms, hipotension and electrocardiographic dynamic changes, she was transferred for an emergent catheterization. Before procedure, transthoracic echocardiogram revealed the presence of a large thrombus in the right ventricle so angio- CT was performed. It confirmed not only a clot but contrasting leakeaged too, allowing inferolateral free wall rupture diagnosis. The patient underwent emergent surgical treatment, that took place without any complications. From the subsequent etiologic study, it stood out an angiography without coronary disease but the finding of an inferolateral infarct scar in the magnetic resonance imaging that suggested previous ischemic event.